Healthcare Provider Details

I. General information

NPI: 1073002234
Provider Name (Legal Business Name): DANIEL & MAX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2018
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9160 76TH ST UNIT C
PLEASANT PRAIRIE WI
53158-1945
US

IV. Provider business mailing address

1615 S CONGRESS AVE STE 105
DELRAY BEACH FL
33445-6326
US

V. Phone/Fax

Practice location:
  • Phone: 262-358-4511
  • Fax: 561-828-8367
Mailing address:
  • Phone: 561-433-6009
  • Fax: 561-828-8367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: KIRSTEN PIPHER CANTRELL
Title or Position: MANAGER OF HEALTH SERVICES
Credential:
Phone: 561-208-8464